Simplified Radiographic Damage Index for Affected Joints in Chronic Gouty Arthritis

Pharmacotherapy for gout

Background: Gout is a common disease that is mainly caused by hyperuricemia. Although it is relatively easy to treat, adherence to drug treatment and the rate at which treatment targets are met is low.Current Concepts: For the treatment of acute gout attack, colchicine, nonsteroidal anti-inflammatory drugs, and glucocorticoids can be used alone or in combination depending on the severity of symptoms. To prevent gout attacks, patients are started on colchicine prior to or concurrent with treatment with uric acid–lowering drugs. The treatment is maintained until serum uric acid levels have returned to normal, and the patient has had no acute attacks for three to six months. Ultimately, the symptoms of gout are controlled in the long term by treating the patient’s hyperuricemia. For this purpose, allopurinol, febuxostat, and benzbromarone are used, and the side effects and contraindications for each drug should be checked. The goal for the treatment of chronic gout is to maintain a serum uric acid concentration below 6.0 mg/dL.Discussion and Conclusion: Patients visit the emergency departments of hospitals for sudden gout attacks. However, gout is a chronic disease that requires the lifelong use of uric acid–lowering agents. Therefore, it is necessary to educate patients on a serum urate-based treat-to-target approach.

[Gout affecting the hip in a 57-year-old woman: case report]

Cette étude rapporte le cas d'une arthrite goutteuse de la hanche, décrite chez une femme de 57 ans, diabétique et hypertendue, sans antécédents de goutte et qui a consulté pour douleur chronique de la hanche droite. L´examen clinique a trouvé une patiente obèse, marchant avec une boiterie droite douloureuse en rapport avec flessum de la hanche homolatérale. La radiographie standard a montré des formations ostéo-condensantes en regard de la face antérieure du col fémoral. La biologie se résume en un syndrome inflammatoire avec un taux normal d´acide urique. La tomodensitométrie et l'imagerie par résonance magnétique (IRM) nous ont orientés vers une chondromatose de la hanche. La patiente a eu un traitement chirurgical avec exérèse complète d´une formation friable et arthrolyse de la hanche. Les prélèvements bactériologiques n´ont pas isolé de germe et l´étude anatomopathologique a conclu à une goutte de la hanche. Un traitement médical à base de Colchicine a été introduit. L´évolution a été marquée par une régression complète du flessum, disparition de la boiterie et amélioration des douleurs de la hanche de façon satisfaisante.

Treatment of atypical gouty arthritis of the hip using total hip arthroplasty: A case report

RATIONALE

Gout and gouty arthritis typically involve peripheral and monoarticular joints, especially the first metatarsophalangeal joint and knees. Hip involvement in patients with gout is rare, and its diagnosis is very difficult, especially in the late stages of the disease. Total hip arthroplasty could be a surgical treatment for atypical gouty arthritis of the hip; however, few cases have been reported.

PATIENT CONCERNS

We reported an uncommon case of a 74-year-old man without typical symptoms of hip gout arthritis whom was misdiagnosed as having avascular necrosis of the femoral head.

DIAGNOSES

Clinical examination and imaging revealed bilateral avascular necrosis of the femoral head. However, the final pathology report revealed left hip gout arthritis.

INTERVENTIONS

The patient underwent left total hip arthroplasty and was followed up for 3years.

OUTCOMES

The outcome was favorable. The function of the left hip was almost normal.

LESSONS

Our case indicated the difficulty of the diagnosis of hip gout arthritis. Due to the lower rates of hip gout arthritis and lack of typical clinical examination, it is easy to misdiagnose. Furthermore, surgical treatment for the late stage of hip gout arthritis has not previously been reported. In our case, total hip arthroplasty proved to be a good option.

Imaging tools to measure treatment response in gout

Imaging tests are in clinical use for diagnosis, assessment of disease severity and as a marker of treatment response in people with gout. Various imaging tests have differing properties for assessing the three key disease domains in gout: urate deposition (including tophus burden), joint inflammation and structural joint damage. Dual-energy CT allows measurement of urate deposition and bone damage, and ultrasonography allows assessment of all three domains. Scoring systems have been described that allow radiological quantification of disease severity and these scoring systems may play a role in assessing the response to treatment in gout. This article reviews the properties of imaging tests, describes the available scoring systems for quantification of disease severity and discusses the challenges and controversies regarding the use of imaging tools to measure treatment response in gout.

Digital tomosynthesis as a new diagnostic tool for assessing of chronic gout arthritic feet and ankles: comparison of plain radiography and computed tomography

This aimed to compare the three radiographic methods of digital tomosynthesis (DT), plain radiography, and computed tomography (CT) for evaluating changes in feet of patients with chronic gouty arthritis. Two independent radiologists read the plain radiography, DT, and CT images of 30 male patients with gout. The degrees of erosion and joint space narrowing were scored using the Sharp-van der Heijde scoring method in 18 foot joints, which consisted of four proximal interphalangeal and one interphalangeal joint of the first toe, five metatarsophalangeal, five tarsometatarsal, and three naviculo-cuneiform joints of the foot. DT showed high reproducibility [0.929 for intraobserver intraclass correlation coefficient (ICC) and 0.838 for interobserver ICC]. DT showed similar results to those of CT and superior results to those of plain radiography for evaluating radiographic damage [mean total score, 8.5 ± 14.6 (±standard deviation) for plain radiography, 12.9 ± 12.4 for DT, and 12.6 ± 11.2 for CT]. This study showed that DT is a good method for evaluating radiographic changes in patients with gout. Further research is needed to apply DT to actual clinical settings.